Month: November 2015

In an extremely welcome move, Jeremy Hunt has resigned, and in an open free-for-all, juniordoctorblog put down all-comers and sat on the Iron Throne of the Health Service to become the new health secretary.

So what to do?

Well, rather than squander this opportunity on a parade of hospital touring photo ops, I think I might fix the health service.

I know, i know : I have to stick to the manifesto, to deliver a 7-day health service, blah blah blah.

My first act is to immediately cease all trust payments to PFI companies – pending further legal action, review of spending and renegotiation, and cancel or restructure all pipeline PF2 deals. This will immediately be legally challenged, which will cost millions. However, in the interim, individual trusts will each save up to £2 million A WEEK [3]. Winter is sorted. After 6 months of negotiation I will nationalise the PFI debt, from the projected £80 billion for £10 billion pounds of services. If I can restructure this debt to payments even a 1/3 less than this I have just saved the NHS £25 billion- money that would continue to come back over the next twenty years. No money spent so far. Budget now £115 billion, plus £35 billion up to 2020. I have just funded the NHS for the next five years.

Meanwhile I will end the internal market. All non-NHS contractors will be brought in house over the next five years, paid at value or less, and the administration for tendering contracts and fighting legal challenges will be scaled back and eventually cut. I will recruit experts in this field, to help dismantle and replace this system. The NHS just saved a conservative £5 billion [4] a year from 2020 onwards – safely funded from 2020-2030. Budget now £115 billion, plus £35 billion up to 2020, then a further £5 billion year-on-year, plus inflation. Ending the internal market also brings back high revenue work such as elective knee and hip operations. I would support the NHS reinstatement Bill [5] and push it through parliament.

I haven’t spent any money yet.

We now have 15 years, of a properly funded health service. Time to invest the surplus.

Firstly: I would triple the public health budget, from £2.9 billion to £7.9 billion, create the Department of Preventative Health, and fund and recruit it to the hilt. It’s independent remit – to improve the general health of the country, via local authorities and nationally. I run a loose ship- so it will have a fairly free reign, but it must demonstrate evidence-based improvement before widespread roll out of any intervention. With 15 years and a decent budget, I expect good things. Funding recreational facilities, in-school sports and exercise facilities, public gyms and outdoor spaces, subsidising fresh fruit and vegetables, and even trialling taxes on ill-health foods would all be tried. If it didn’t work, it goes in the bin. Cost: an extra £5 billion and 10 years investment. Potential savings are huge- if you estimate disease costs caused by avoidable risk factors and aimed to reduce these by just 10%- you could save from smoking £200 million a year, from obesity £200 million a year, from hypertension £200 million a year, and £1 billion a year from diabetes. Total savings; £1.6 billion/year, but a long way down the line. Eventually pays for itself.

Next I would push to integrate the NHS and social care budgets, and then make it my remit as health secretary to double the adult social care budget from £13.9 billion [7] to £23.9 billion with NHS money. I would establish in-house community care – carers would be employed by the NHS and rotate between at home care work and nursing homes. Home carers would be NHS-trained and qualified. Alongside this I would provide on-call medical cover- carers would be training to an HCA level to look out for early illness and those who are sickest would have access to a visiting GP. Again, all programmes would be piloted scientifically to demonstrate benefit. Care of the elderly MDTs would be specifically funded, based in the community, to review and prevent illness in the over 75’s- as long as the evidence [7] continues to show cost-effective benefit. Limits of treatment discussion would be a standard quality indicator for the programme.

So far- I have spent an additional £15 billion of £35 billion by 2020.

I would spend a further £10 billion over fiver years on long-term recruitment and incentivisation for permanent nursing staff, based on recommendations from Royal College of Nursing. I would spend a further £5 billion on the same recruitment and retention for doctors, to increase doctors/head to at least the OECD average 3.2/1000 and £2.5 billion on supporting professionals- radiographers, pharmacists, physiotherapists, occupational therapists. Yes, all clinical staff would see pay rises.

So- fixed staff morale and numbers, fixed public health and social care, saved billions in prevented falls and disease- and still an extra £2.5 billion leftover. At this point a seven-day routine care model might naturally materialise with proper staff and resources- it would need proper trialling for uptake however, and if it didn’t work, it would be scrapped.

Now to get bold. I would scrap both monitor and the CQC- saving millions. In 2017 I would launch a £2 billion initiative, to place and recruit medical MDT teams trained and tasked solely with the responsibility for quality improvement into every hospital and trust. Any intervention has to show patient benefit and be cost-effective. The team is independent from the hospital and responsible for collating all DATIX reports and never events and organising and implementing the root cause analysis and the changes. They would organise hospital Mortality and morbidity meetings, support QIP projects with funds and support services and have a duty to report and improve unsafe practice.They are answerable directly to the Department of Health, and have power over every aspect of hospital management and budget as needed to protect patient safety.

All patient data is placed into an anonymised, opt-out, national database of outcomes, freely accessible for health research to any of my departments. With such large numbers, new data and initiatives can be evidenced properly before formal studies begin.

Whew. Now it’s 2020 and the NHS looks pretty healthy to me. Not a penny of extra money overall has been taken from the treasury. If I’m still in office I would now expect individual hospitals to be reporting, via their internal quality monitors, what they need. I would put aside a further £2 billion fund to trial any major improvement. This would be rolled out everywhere if it was successful.

At this point I will begin the drive to increase funding for the health service to equivalent OECD levels, by at least 1-2% more GDP spending. I would demonstrate the economic benefits of having a properly funded and preventative health system, hopefully increasing the budget by a further £20-30 billion.

And then, after 15 years as the greatest health secretary since Bevan, I would change the law so to limit the powers of the Health Secretary, appoint several heads of the NHS outside of political influence and mandated to spend based on evidence and cost/effectiveness alone, and transparent public spending of money. The law would also mandate that budgets for trialled initiatives are ring-fenced outside of political interference for a defined time period- this is to stop wasting money by cutting funding before projects have a chance to show benefit.

I would be open to any evidence-based argument to implement any policy that showed patient benefit and was cost-effective. As I said, I run a loose, evidence-based ship. And then I would retire, having set up the NHS to remain one of our greatest national achievements for the century to come.

The Panel has now considered whether your fitness to practise is impaired by reason of misconduct.

The Panel has considered the submissions of 17,000 doctors on the streets in Westminster, all of the major UK newspapers and media television news services, 3000 signatories to the letter of misconduct submitted to the Cabinet Office, the 53,000 junior doctors currently in the UK and 223,000 signatories to the online e-government petition “To debate a vote of no confidence in Jeremy Hunt”. We have also considered submissions from the BMJ, and the Doctors and Dental Remuneration Body.

The proven facts of your case can be categorised into four areas, as follows:

Honesty and integrity

Confidentiality

Standard of care

Professional conduct

Juniordoctorblog referred the Panel to the GMC’s guidance, ‘Good Medical Practice’ (April 2013) (GMP), which sets out the duties and responsibilities of a registered medical practitioner. Specifically, the headline duty of maintaining trust, and paragraphs 7, 15, 20, 36, 37 and 69 which state:

Duties of a doctor: Maintaining trust: Be honest and open and act with integrity.

7. You must be competent in all aspects of your work, including management, research and teaching.

15. You must provide a good standard of practice and care.

20. You must keep records that contain personal information about patients, colleagues or others securely, and in line with data protection requirement

36. You must treat colleagues fairly and with respect.

37. You must be aware of how your behaviour may influence others within and outside the team.’

69. When communicating publicly, including speaking to or writing in the media, you must maintain patient confidentiality.

The Panel’s decision

In deciding whether your fitness to practise is impaired, the Panel has exercised its own judgement. It has borne in mind its responsibility to protect the public interest and, in particular, to protect patients.

The Panel considered whether the admitted and proven facts in your case amounted to misconduct that was so serious as to impair your fitness to practice.

In regards to dishonesty: Found proved. On repeated occasions you have misrepresented several research papers and several government polices, which this Panel would expect you to have a good knowledge of. We find your dishonest conduct deliberate. Specific evidence considered:

Misrepresenting the 2015 Fremantle BMJ paper, ‘11,000’ deaths at the weekend on frequent occasions; Telegraph, BBC, Kings Fund, Guardian. Which may have led to active harm to patients.

Misrepresenting the HISLAC data , in a discussion about junior doctors contracts on the Today programme, on the morning of the second Junior Doctor protest.

Claiming the BMA is misleading members – the Panel considered evidence from independent doctors numbering in the tens of thousands on Twitter, and protesting around the country, independent and government petition websites, and newspaper interviews, and found no evidence of BMA ‘misrepresentation’.

Claiming #Dangermoney is a ‘colloquial‘ term in the NHS- despite 99.67% of 1201 doctors surveyed never having heard the term.

In regards to breach of confidentiality: Found proved. You have broken the most fundamental aspect of healthcare, and show no remorse over your behaviour.

On July 18th 2015, at 2:34pm, you uploaded a photo to over 70,000 twitter followers which contained the names and operations of several patients at a major London hospital.

You have made no formal apology

In regards to poor standard of care: Found proved

This Panel understands you have approximately 65 million patients in your care at any given time

This Panel understands that the NHS deficit budget is estimated to be £2 billion this year alone

This Panel understands you have misunderstood the budget and the proposed ‘additional funds’ on several occasions – this mismanagement is actively harming patients

This Panel considered evidence of the ‘Hunt Effect’ detailing patients coming to active harm having been misinformed by yourself in regards to weekend staffing and safety: formal evidence is still pending.

For proposing a contract purported to be ‘safe for patients’ but which removes the fundamental safeguards that protected patients from doctors forced to work overlong hours.

In regards to poor professional conduct: Found proved

Your treatment of your colleagues has been considered: your conduct during the recent Opposition Day debate was inappropriate- disrespectful to fellow MPs and colleagues in the NHS, including walking out halfway through the debate.

Your comments regarding the ‘Monday to Friday’ culture of the NHS, your belief that a computer could do a doctors job, your claim that doctors are ‘misled’ by their union, and are incapable of studying the evidence themselves and making their own decisions, your fundamental lack of insight into the entire system you are in charge of.

You have not treated colleagues fairly or with respect.

In summary:

Mr Hunt is found to be impaired in his fitness to practice. He will…

Oh?

Not a doctor?

Apologies Mr Hunt. Please receive your affects at the door:

A copy of the 2015 Fremantle BMJ paper, torn, and heavily annotated with exclamation marks and maniacal laughter.

A copy of the Junior Doctors Contract, which apparently does not yet exist, but is ready to be imposed.